As a health reform, the massive impact of the bill to restructure the drug market (AMNOG) on the earnings situation of pharmacies has been almost without precedent. It has been valid since January 2011. As part of the second implementation phase of AMNOG – which, among other things, saw the elimination of wholesale rebates – pharmacies are facing a year which will determine their future direction. Many pharmacists are therefore complaining about their tense economic situation. However, the consequences can also be seen in the steadily falling number of pharmacies in Germany, currently 21 238, which, according to ABDA, has reached its lowest level in 15 years. A bad business prognosis was also confirmed by current results of the pharmacy economy index (APOkix) published by the Institute for Trade Research (Institut für Handelsforschung): Almost 87 percent of pharmacies are expecting less revenue for the year 2012. Thus the pharmacists‘ assessment of their business situation is bleak.
In view of the constantly decreasing margin for local pharmacies, it is worthwhile to look at the newest developments in a foreign pharmacy market. France has recently passed a new payment system for pharmacies as part of their health insurance reforms. It ensures pharmacies have more primary care competencies. For example, from 2013 onwards, pharmacists will receive additional payments in the form of a consultation fee and other remunerations for new medication management for chronically ill patients. Furthermore, they will receive surcharges for night and emergency services as well as adherence to a predetermined quota of generics. In the next five years, earnings from pharmacy fees are already supposed to constitute a quarter of their revenues.
In Germany pharmacists traditionally rely – in part because they do not trust that political changes will be for their benefit – on added value which is exclusive to a pharmacy because it represents high-quality customer service concerning medical products. This is the context of the model project by ABDA and KBV’s "Future Concept in Medical Products Services“. In essence, this is about increasing patients‘ compliance, because during long-term therapy only every second person takes their medication as prescribed by the doctor. The pharmacists‘ aim is to demonstrate that intensive patient consultation and medication management improves medication compliance of patients which in turn saves costs. If health funds actually do save costs by implementing the future model, participating doctors and pharmacists should benefit from it as well.
The details of the future model by ABDA and the Federal Association of Statutory Health Insurance Physicians (KBV) have to be conceptualized and coordinated with the health funds. Furthermore, the ABDA and German Pharmacists Association (DAV) have been fighting for an adjustment of fees which is long overdue.
The main issue of the joint concept is the greater cooperation of doctors and pharmacists to ensure a safe drug therapy. To do this, the doctor prescribes an active ingredient on the basis of a medication catalog. He also determines the amount, dosage and length of therapy. The pharmacist subsequently chooses the correct medication and dispenses it together with the appropriate advice. Patients who are taking more than five medications long-term might also be in line for medication management. The insured will then receive a medication plan which shows exactly which medication he has to take at what time and in what dosage.
From the viewpoint of the funding system, the French approach to lowering expenses for medications is to be understood as an attempt to promote outpatient care services in favor of inpatient services. (…) The French reimbursement system is to be financed by a set quota of generics and decreased hospital admissions.
Moreover, focusing on services by healthcare professionals as well as an increased commitment towards prevention are supposed to contribute to raising the profile of pharmacies, too. This is also necessary within the context of clear positioning compared to mail-order pharmacies and vendors from other sectors, for instance drug stores.
Changing the payment system in Germany:
Although the future model involves additional services, and therefore costs, for pharmacies, any fees in connection with it cannot replace the pharmacy payment adjustments demanded by ABDA and DAV. To the contrary: They are more urgent than ever. Since the new drug price regulation took effect in 2004 there have been no other changes. Costs and expenditures have risen, but fees have not.
Nowadays, formulations or night and emergency service means pharmacists are out of pocket. As a rule, these activities are money-losing business.
To be sure, there will probably be more laws to contain costs for the statutory health insurance (GKV) in the next few years, which will also impact on pharmacies. However, a fundamental reform of the pharmacy market, for instance by completely abolishing the ban on foreign ownership, has been broached repeatedly, but is as yet not in sight. In any case, German pharmacists are not likely to be convinced by the introduction of such measures in this country, seeing that within the framework of APOkix they handed down an average school report mark of 5.4 (deficient) to health politicians.
It is difficult to predict what the chances are of receiving fair remuneration this year. Politicians, naturally, also know about the economic problems experienced by many pharmacies. The date of the federal elections in autumn 2013, however, is getting closer, too. A fee adjustment for pharmacies will definitely not be popular with all voters.
At the press conference, ABDA presented suggested solutions for the pharmacists‘ plight. "We need to match the payment system with cost developments; which means: adjusting payments per package. Night and emergency services, the producing of formulations and dispensing of narcotic substances have to be paid in such a way that they reflect the work performed," says Wolf.
Open questions in this context are: What might pharmacy managers themselves do to continue to be successful in economically difficult times? How should pharmacists‘ work be paid? Exclusively through distribution margins or also through fees for other services?